Cannabis for Medical Purposes – Revised Reimbursement Policy

Questions and Answers

Q1. How will the legalization of recreational cannabis impact VAC's reimbursement policy for cannabis for medical purposes?

A1. The Department has updated the language in its current Reimbursement Policy for Cannabis for Medical Purposes to account for the legislative changes. Veterans will experience no change in the current reimbursement process for cannabis for medical purposes.

Q2. What is this federal excise duty I keep hearing about?

A2. As a result of legalization, there is a new federal excise duty on cannabis. This excise duty will be absorbed by the federal licensed sellers. At this time, the Department's maximum reimbursement rate will remain the same.

Veterans Affairs Canada (VAC) reimburses at a rate of $8.50 per gram, which is deemed fair market value.

Q3. Will the maximum reimbursement price of $8.50 change?

A3. At this time, there will be no increase in the Department's maximum reimbursement rate of $8.50 per gram of dried cannabis, or its equivalent in fresh cannabis or cannabis oil.

Numerous federal licensed sellers offer some of their strains at this price point, meaning that Veterans are able to access a variety of products within the reimbursement amount.

Q4. What is the provincial excise duty?

A4. In addition to the federal excise duty introduced on cannabis products in October 2018, certain provinces and territories (Alberta, Saskatchewan, Ontario, and Nunvut) also introduced a provincial excise duty. The additional provincial excise duties are as follows:

Alberta – 16.8%

Saskatchewan – 6.45%

Ontario – 3.9%

Nunavut – 19.3%

If you wish, you may transfer your medical authorization document from one federal licensed seller to another without getting a new medical authorization document from your health care practitioner, as long as it is still valid. Your new federal licensed seller will contact Medavie Blue Cross to get authorization for direct billing.

Q5. I heard I can change federal licensed sellers without getting a new medical authorization document from my health care practitioner. Is this true?

A5. Yes. You may now transfer your medical authorization document from one federal licensed seller to another without getting a new medical authorization document from your health care practitioner, as long as it is still valid.

Your new federal licensed seller will contact Medavie Blue Cross to get authorization for direct billing.

Q6. As recreational cannabis is now legal, why does VAC have a limit on the amount of grams reimbursed to Veterans? Will the limit of three grams be increased, or lifted now that cannabis is legal?

A6. VAC's reimbursement limit for cannabis for medical purposes will not change with the introduction of this legislation. Also, the exceptional approval process remains in place for any Veteran requesting reimbursement for more than three grams per day.

The reimbursement policy was based on the published guideline from the College of Family Physicians of Canada, that advises that, "...the upper level to the safe use of dried cannabis will be on the order of 3.0 g per day, and that even this level of use should be considered only in very circumscribed conditions."

You can still purchase up to your authorized quantity, but VAC will only reimburse up to three grams per day, unless you have a favourable decision for an exceptional approval.

Q7. If the use of recreational cannabis is legal, why does VAC require I see a health care practitioner to get a medical authorization document in order to reimburse me?

A7. As of October 17, Canadians can legally access cannabis for recreational purposes.

However, cannabis for medical purposes is regulated by Health Canada, and VAC's reimbursement policy reflects this.

Federal licensed sellers require a medical authorization document as part of the registration process with their customers.

Both Health Canada and VAC's reimbursement policy require that Veterans must register and purchase cannabis for medical purposes from a federal licensed seller within Canada.

Q8. If the use of recreational cannabis is legal, why does VAC require I see a medical specialist to provide additional information supporting my use of more than three grams per day?

A8. As of October 17, 2018, Canadians can legally access cannabis for recreational purposes.

However, cannabis for medical purposes is regulated by Health Canada, and VAC's reimbursement policy reflects this.

In order to be reimbursed for more than three grams per day, VAC requires additional documentation from a medical specialist with expertise in the diagnosed condition for which you are being treated by cannabis.

The specialist's medical rationale for using more than three grams per day supports the medical authorization document provided by your health care practitioner, keeping your health and well-being at the forefront.

Q9. Can I still purchase cannabis through my federal licensed seller through direct billing?

A9. Yes. You may continue to purchase cannabis from the federal licensed sellers through direct billing.

Q10. Can I be reimbursed for the product I purchased at a provincial retailer?

A10. No. You will not be reimbursed for cannabis sold at provincial retailers. Per Health Canada's Cannabis Regulations, cannabis for medical purposes must be purchased through federal licensed sellers.

Federal licensed sellers are governed by Health Canada's regulations in order to ensure the quality of their product. Having Veterans access these products through federal licensed sellers provides the Department the assurance that the product is regulated and controlled, so that the health and well-being of Veterans is always at the forefront.

Q11. Will there be enough supply of cannabis for medical purposes if everyone can buy cannabis?

A11. Following the legalization of recreational cannabis on October 17, 2018, Veterans Affairs reached out to a number of federal licensed sellers, who verbally confirmed that their priority is to ensure that their medical patients get the product that they need. However, as federal licensed sellers are privately-owned enterprises, Veterans Affairs Canada does not have control over cannabis supplies. Health Canada regulates federal licensed sellers. You may contact Health Canada at cannabis@canada.ca if you have concerns regarding the supply of cannabis available.

Q12. Where can I find information on possession limits?

A12. Veterans should carry a copy of their registration certificate as proof that they can possess a limited amount of cannabis for medical purposes. Under the Cannabis Act, in public, you may possess the lesser of 150 grams or a 30-day supply of dried cannabis (or the equivalent in cannabis product), in addition to 30 grams allowed for non-medical purposes. (Source: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/medical-use-cannabis.html#_Possession_and_personal

For more information, visit the Department of Justice website (www.justice.gc.ca). Under the “Criminal Justice” tab, choose “Cannabis Laws and Regulations.”

Q13. Where can I find more information on impaired driving?

A13. It is illegal to drive while under when under the influence of cannabis.

Check your provincial or territorial laws to determine what additional administrative penalties may be imposed upon you, in addition to any criminal penalties, for impaired driving where you live.

For more information, visit the Government of Canada website (www.canada.ca) and enter “cannabis by province” in the search bar.

Q14. My local health care practitioner will not medically authorize cannabis for me, so I have to travel. Does Veterans Affairs Canada reimburse travel costs incurred to obtain the services of a health care practitioner who will medically authorize cannabis for medical purposes?

A14. Yes, however you must visit the nearest treating centre to your residence, and the travel must be pre-authorized.

Round trips under 400 km must be pre-authorized by a case manager or Client Service Agent. Round trips over 400 km must be pre-authorized by a Veterans Service Team Manager.

Q15 How do I request an exceptional approval?

A15. You must provide documentation from an appropriate medical specialist. They must have expertise in the condition for which you are medically authorized for cannabis for medical purposes.

Each claim will be reviewed on a case-by-case basis and must explain why more than three grams per day is necessary to treat your condition. Once you submit your paperwork, your file will be reviewed, a decision will be made, and you will be notified in writing of the decision.

In end-of-life situations (as defined in the policy), documentation is not required from a medical specialist.

Documentation from your specialist should be sent to:

Medical Authorization Centre – Pharmacy
Medavie Blue Cross
PO Box 6200 STN LCD1
Moncton NB E1C 8R2

Q16. Who are medical specialists for the exceptional approval process?

A16. For mental health: a psychiatrist only

For a neurological condition: a neurologist, internal medicine

For cancer: an oncologist, internal medicine or hematologist or hemato-oncologist, radio-oncologist, or any other sub-specialty of oncology.

For pain: pain specialists could be internists, neurologists, anaesthetists, physiatrists (physical medicine and rehabilitation specialists), orthopaedic surgeons, and GP or Family Physician and/or any other physician not mentioned above that have been credentialed by the Canadian Academy of Pain Management -the list of those credentialed can be found at: http://www.canadianapm.com/credentialing_bios.html

For example, a Veteran who has pain from cancer would need to provide medical documentation from an oncologist to request an exceptional approval. A Veteran who is suffering with mental health issues would need to provide medical documentation from a psychiatrist.

Veterans diagnosed with chronic pain and a psychiatric condition only need one medical specialist's rationale.

Q17. How often do I need to see the specialist to get reimbursed?

A17. A letter from your medical specialist supporting the use of more than three grams per day has a validity period of two years, provided there is no change in quantity of cannabis being authorized by your treating health care practitioner. Your medical authorization document can only be valid up to one year. You must ensure that it is valid.

Q18. If I am medically authorized to use cannabis for medical purposes for both chronic pain and a psychiatric condition, do I need supporting letters from two specialists for my exceptional approval request?

A18. No. Veterans diagnosed with chronic pain and a psychiatric condition only need one medical specialist's rationale.

Q19. What is meant by 'other qualified individuals' in the policy?

A19. Other qualified individuals may include civilians and RCMP personnel eligible for treatment under the Veterans Health Care Regulations.

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